COVID-19 — a Catalyst for Health Ecosystem Urgent Change
At the outbreak of world war, two potential competitors would bring their combined resources and talents to the table. Forrest E. Mars, Sr. would collaborate with Bruce Murrie on an idea with the potential to help American combat soldiers in the field. Their idea would find its initial success on European battlefields, and when the world was finally at peace, it would secure a lasting place on the nation’s candy store shelves. In the spirit of partnership, the confectionary inventors would jointly name their now iconic creation using initials from their last names: M&Ms. Beyond candy, this global crisis was the catalyst that drove countless advances in computing, supply-chain management, telecommunications and rocket production. Each a step toward greater human achievement.
The adage “necessity is the mother of invention,” has been proven true, time and time again. Vital ideas that have become mired in the false comfort of the status quo are thrust into the open and into broader use when societies are threatened economically, medically or politically. The Great Depression, polio surges, and World War II forced quantum changes in economic structures, drove development and access to medicines, and unleashed nations’ industrial might. The COVID-19 virus, our national and global public-health urgencies, and possibilities of a global recession, are destined to do the same for a number of “what is taking us so long” digital health technologies that have struggled for greater adoption until now.
IS COVID-19 PUSHING OUR HEALTH SYSTEM TOWARD CHANGE?
In their New England Journal of Medicine (NEJM) Perspective, “Covid-19 and Health Care’s Digital Revolution” co-authors Sirina Keesara, M.D., Andrea Jonas, M.D., and Kevin Schulman, M.D., write:
“In a very real sense, the spread of COVID-19 is a product of the digital and technological revolution that has transformed our world over the past century. Unlike the “Spanish flu” of 1918, which became an international epidemic over the course of a year, COVID-19 has spread to every inhabitable continent within weeks, outpacing our health system’s ability to test, track, and contain people with suspected infection. To continue functioning, private companies and institutions of higher education have made an abrupt transition to remote videoconferencing and other digital solutions, while the health care system is still managing this crisis largely through risky brick-and-mortar visits.”
We are facing a global conflict, a pandemic that has the people and health systems of nearly every country in the world in its grip. Separated by household fear and government policies, technological advances are now making their way into the mainstream. Once established, they will not retreat, and neither will consumers or health professionals walk away from them once their potential for lasting benefit is experienced.
WE WILL DEPLOY THESE INNOVATIONS TO BUY TIME AND SAVE LIVES
Here are three innovation platforms that are poised to transform the character of medical and access innovation that the crisis of COVID-19 will accelerate. Each have confronted challenges to broader adoption. Urgency and practical experience will play an essential role in driving their value message and expanding their beachheads:
1. Telehealth + Chatbot: COVID-19 is kick-starting a wave of medical access innovation. Suddenly, medical conversations, health professional compassion and patient care are converging around these two technologies. Exactly one year ago, an American College of Physicians survey listed a number of drivers of and obstacles to implementing telehealth programs. Slightly more than 50 percent of physicians participating in the ACP survey stated that they had tried telehealth services. The biggest hurdle to greater use cited by 34 percent of these physicians wasn’t their buying into the tech, it was getting their health systems to open the door to acceptance. COVID-19 has torn-down that barrier to entry.
The Amazon Prime culture of “consumerism at my doorstep now” is making its way into medicine at full speed. Whether it’s for initial coronavirus screenings or triaging medical priorities, provider systems are adapting quickly in order maintain patient flow and revenues and protect health staff and potential non-virus patients.
For systems late to the party, no worry: telemedicine is about to make its next leap forward with chatbot. Like early stage jet propulsion paving the way to global and space travel, the big drivers in telecommunications, artificial intelligence and voice technology, are combining to perfect chatbot. And, forget about digitized artificial voices: it’s about to feel and sound “real.”
In June 2018, the digital-health futurist John Nosta wrote in Forbes:
“I’m a fan of telemedicine. And I believe it’s an important tool in advancing digital health and providing superior care to a wide variety of individuals. But in today’s world of exponential changes, one can argue that if it works, it’s already obsolete! The struggle of telemedicine’s well-financed journey may be at the proverbial tipping point. But the tip might be toward a new, technology-empowered option, that makes that phone chat with a doctor already yesterday’s news.”
Nosta nails it; COVID-19 has made telehealth + chatbot the new competitive customer-service advantage for payers and provider systems.
2. Virtual Clinical Trials: Using technology to make clinical trial participation easier for their participants seems simple and “customer-centric,” and yet, trial site managers and industry have been reluctant to change the way they have always conducted trials. But COVID-19 has shattered the old models. The disease is forcing traditional clinical drug development and many trial sites grinding to a halt. Standby and get ready for change!
Almost a decade ago, Pfizer ventured into the virtual clinical trial space with the REMOTE trial (Research On Electronic Monitoring of Overactive Bladder Treatment Experience) for hyperactive bladder. REMOTE was the first randomized clinical trial with patient recruitment and data collection using web and smartphone.
REMOTE was a brilliant idea, but it failed due to several challenges. The most fundamental of these was that 10 years ago, the idea was launched before its time. Now, with Zoom family gatherings and business meetings, we are ramped up for the virtual connection that COVID-19 forces us to adopt.
Craig Lipset, then a Pfizer executive and now founder of Clinical Innovation Partners, was one of the REMOTE pioneers; he shared recently how COVID-19 is going to impact drug discovery in Clinical Leader:
“Protocol, patient monitoring, and even some endpoints will have to change. One result of the pandemic is that organizations will begin to embrace more resilient, and often digitally enabled, endpoints that support options for remote participation. Unfortunately, most sponsors are scrambling right now because their study endpoints are so fragile, they cannot be captured outside the clinic.”
As Chantal Beaudry, senior partner, Lazar/FINN Partners, who is an expert on clinical trial recruitment, notes:
“Dealing with Covid-19 forces us to embrace our ‘virtual reality’ and teaches us that we can leverage technology successfully to advance medicine and engage with patients, providing an expected inflection point for the broader adoption of virtual clinical trials.”
COVID-19 — that it places the world community at risk — reinforces the need for speed in drug discovery and development. Coronavirus makes everyone a potential patient. Industry, government, academic medical centers and patient advocates will be calling for trial protocols that make things easier for participants — from people-friendly virtual participation to the use of synthetic data control arms. Without sacrificing efficacy, safety or speed to sustain and save lives will be a driver.
3. Digital Health: How medical systems register, track and engage patients has been forever changed by the fast-moving virus. Now, overworked medical teams are tracking their patients’ emotional, physical and medical progress remotely — using digital technologies.
Those digital technologies are becoming mainstream — doing exactly what they were created to do in the “accelerator” of COVID-19. Smart beds transmit patient vitals wirelessly to nursing stations. Smart home systems perform regular check-ins, monitoring symptom severity and setting reminders to take meds and prompts to check temperature. Artificial intelligence analyses segment people’s risk data to interactive apps with a COVID-19 dashboard for professionals to engage patients and plot population health strategies.
In these innovative ways, digital health advances have joined the care frontlines. The digital-health genie too-often snubbed by health systems operationally, is now showing its value by enabling consumer and health professionals to connect and mobilize. While some apps answer the call of the hungry social distancer, other apps are coming into their own, serving as an public health GPS alert system showing COVID-19 patient hotspots.
John Whyte, MD, chief medical officer at WebMD and a former leader within both the Centers for Disease Control and the Food and Drug Administration shares:
“I cannot see how anyone will want to go completely back to a system that requires physical presence. Sure, people will still need to come to the doctor for some ailments and symptoms. But why drive miles and wait in a crowded room when you get do many things from the comfort of your living room sofa? We also need to embrace patients receiving more care in their home — including treatment for cancer as well as clinical trials. The need for social distancing has allowed us the opportunity to rethink how we deliver care. The changes that we are making will not just last during the epidemic but will persist in many forms when this all resolves. Innovation is here and we won’t go back to the way it was!”
IS THIS THE RIGHT TIME FOR A COVID-19 MANHATTAN PROJECT?
These three industry segments are primed for acceleration. Innovation success depends generally on financial capital, clear value and system-wide support. Historically, the post WWII mindset was first to the market takes all. That carried over to diagnostic and drug discovery. Now, in the face of COVID-19, that “to the victor belong the spoils” model is being challenged.
Like a “Medical Manhattan Project,” COVID-19 reminds us that sustaining life and putting commerce back on track requires many innovators working shoulder to shoulder — bench to bench. Can we imagine just one diagnostic approach addressing pressing testing needs? How about one therapeutic or vaccine development program being the only one investigated? Speed, data, efficacy and safety require team effort with payers, patient/professional groups, policymakers, product innovators and providers working around the table and around the clock — collaboratively.
Competition is a powerful emotional driver. The desire to achieve and change the world is enticing. It is a catalyst to overcome great challenge. United with its complement — collaboration — we unleash a composite EQ for overcoming the mammoth coronavirus challenge. Amir Kalali, MD, physician andscientist, founder and curator of the CNS Summit — one of the great life science gatherings, which attracts more than 800 digital health, biopharma and clinical trial leaders interested in finding common ground, reflects on how innovative behavior impacts output in a CenterWatch interview:
“Collaboration, innovation and technology are things that life science companies can do much better on. Anytime you have scientists being in the same area is a plus. Being able to come out of your own four walls and interact with others who may have a different perspective on the same problem generates new ideas and solutions. The more diverse we are around the problem, the better.”
TECHNOLOGY AND HUMAN TOUCH — HARD SHELL AND SOFT INSIDE
Collaboration is key to moonshot success. Confectionery legends Mars and Murrie put their heads together to combine resources and talents for the benefit of frontline troops. Together, they would develop a novel idea that, once introduced, would become quickly established as enduring part of the American cultural landscape. Though M&Ms are a lighthearted example of the benefits of competition and collaboration combined, they’re emblematic of the idea that earthshaking global events have the effect of driving enduring innovation.
Likewise, COVID-19 will push forward ideas and innovations that that will sustain and save lives now and in the future. Many of these technologies are in our hands right now. Telehealth and chatbot, virtual trials and synthetic data, digital health and collaborative mindsets. NEJM authors Keesara, Jonas, Schulman call upon us to adopt technologies that will improve care quality and reduce the cost of health services. COVID-19 is our common foe and while human touch may help it spread quickly, make no mistake, only by using the full potential of technological innovation united by our humanity, we will we be able to beat it.